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General NPI Number Information
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NPI Number | 1225406101
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Entity Type | Organization
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Legal Business Name | DENTAL CARE OF MANHASSET, P.C.
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 09/09/2015
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Provider Practice Location Address
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Address Line | 1185 NORTHERN BLVD
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City | MANHASSET
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State | NY
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Zip | 11030-3017
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Country | US
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Telephone | 516-441-5142
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Fax | 516-441-5146
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Provider Business Mailing Address
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Address Line | 1185 NORTHERN BLVD
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City | MANHASSET
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State | NY
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Zip | 11030-3017
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Country | US
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Telephone | 516-441-5142
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Fax | 516-441-5146
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LEV YUSUPOV
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Credential | DDS
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Telephone | 516-441-5142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 50-057503
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License Number State | NY
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